NPIMap

Organization Active NPI

Dr Timothy Berger

  • Dentist
  • Fort Wayne, IN
National Provider Identifier
1114212461
Registry record updated Jun 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12008676 Issued in IN
Legal business name
DR TIMOTHY BERGER
Practice address
1620 Saint Joe River Dr
Fort Wayne, IN 46805-1434
Phone
(260) 482-4202
Fax
(260) 482-5232
NPI assigned
Jun 15, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Timothy S Berger, D.M.D.NPI 1790725489
Title
Owner
Phone
(260) 482-4202

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 12008676 IN Primary

Addresses

Primary practice location

1620 Saint Joe River Dr
Fort Wayne, IN 46805-1434

Mailing address

1620 Saint Joe River Dr
Fort Wayne, IN 46805-1434
Phone (260) 482-4202

National Provider Directory

National Provider Directory

Locations

1620 Saint Joe River Dr
Fort Wayne, IN 46805
Phone (260) 482-4202

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1308096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308096000000",
    "number": "1114212461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 SAINT JOE RIVER DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051434",
            "telephone_number": "260-482-4202",
            "fax_number": "260-482-5232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 SAINT JOE RIVER DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051434",
            "telephone_number": "260-482-4202",
            "fax_number": "260-482-5232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR TIMOTHY BERGER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-15",
        "last_updated": "2011-06-15",
        "status": "A",
        "authorized_official_last_name": "BERGER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "260-482-4202",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12008676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.